The intervertebral discs function to sustain and distribute loads as well as to prevent excessive spinal motion. The discs lie between each of the vertebrae along the spine. Intervertebral disc syndrome comprises the following: herniation; rupture or prolapse of a vertebral disc. The nucleus pulposus of an intervertebral disc protrudes from or breaks out of its normal surroundings. It may also be known as herniated or slipped disc, herniated intervertebral disc (HIVD), or herniated nucleus pulposus (HNP).

In general, this syndrome may result from the following: trauma, deterioration as part of the aging process, or disease.

Signs and symptoms of the condition include pain that worsens by movement of the spine, the Valsalva's maneuver, coughing, laughing, or straining during defecation. Paresthesias and deep tendon reflexes may be depressed or lost. In addition, with lumbosacral herniation, straight-leg raising may result in back or leg pain; and with cervical herniation, neck flexion may cause discomfort. Muscles supplied by the damaged root may become weak, atrophied and flaccid, and may exhibit a contraction or twitching motion. Furthermore, compression of the cervical cord may cause complete or partial paralysis of the lower limbs. Finally, compression at the end of the spinal cord (cauda equina) usually results in urinary problems.

Diagnostic tests for the condition would most likely include: spinal x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI) electromyography studies, and myelogram.

Moderate treatment is usually instituted because most patients with low-back or nerve-root pain recover without surgery. Rest and relaxation may be sufficient to relieve acute pain or, if needed, medications may provide relief. However, if the case involves progressive or severe neurologic deficits, surgery e.g., laminectomy, or surgical decompression are indicated.

Regardless of treatment, symptoms may occasionally persist.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses.

• Of an evaluation is assigned based on incapacitating episodes, a separate evaluation may not be assigned for loss of motion, radiculopathy, or any other associated objective neurological abnormality as it would constitute pyramiding.

• There is no presumption of service connection for degenerative disc disease under 38 CFR 3.309(a).

• For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

• If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine). The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

• Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25.